Healthcare Provider Details

I. General information

NPI: 1215817846
Provider Name (Legal Business Name): EXPRESS CARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 ARLINGTON RD STE B
BROOKVILLE OH
45309-1103
US

IV. Provider business mailing address

430 ARLINGTON RD STE B
BROOKVILLE OH
45309-1103
US

V. Phone/Fax

Practice location:
  • Phone: 326-699-6100
  • Fax: 326-699-6112
Mailing address:
  • Phone: 326-699-6100
  • Fax: 326-699-6112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHELBY LYNN GONSALES
Title or Position: OWNER
Credential:
Phone: 937-867-7700